Preventitive Medicine-GI Diseases

Question 1

A 52-year-old man comes to see you complaining of HTN and HLD. He hasn’t seen a doctor in 2 years. He has a 30 pack-year history and BMI of 23. What prevention measure should you do to prevent GI/hepatic disease in this patient?

Answer 1

You need to do grade A screening for colorectal cancer between ages 50-75: annual FOB testing, sigmoidoscopy every 5 years + FOB every 3 years or colonoscopy every 10 years.

Question 2

C recommendation for colorectal cancer screening?

Answer 2

Counsel against routine screening for colorectal cancer in adults age 76-85 due to complications.

Question 3

D recommendation for colorectal cancer screening?

Answer 3

Don’t screen in people > 85 years old because risks outweigh benefits

Question 4

I statement for colorectal cancer screening?

Answer 4

There is insufficient evidence of value of screening with CT colonography or fecal DNA testing

Question 5

B recommendation for hepatitis B screening?

Answer 5

Screening patients at high risk for infection has good benefits

Question 6

A recommendation for hepatitis A screening?

Answer 6

Pregnant women should definitely be screened

Question 7

B recommendation for hep C screening?

Answer 7

High risk people and one time screen for people born 1945-1965

Question 8

D recommendation fo pancreatic cancer

Answer 8

Do not screen regularly for pancreatic cancer in asymptomatic adults

Question 9

After exposure to a known infected patient (Hep B, C and HIV) what is the likelihood of getting infected?

Answer 9

HBV = 30%, HCV = 3%, HIV = 0.3%

Question 10

Protocol for HBV pre-exposure vaccination for health care workers

Answer 10

3 shot series then test for HBsAb 1-2 months later. If negative redo 3 shot series.

Question 11

Protocol for HBV post-exposure prophylaxis

Answer 11

Give HBIg and HBV vaccine booster if the patient is HBsAG positive and the worker is HBsAb negative

Question 12

Protocol for HBA post-exposure prophylaxis

Answer 12

HAIg (infants and 40+, immunocompromised) or HA vaccine (1-40 years) within 2 weeks of exposure

Question 13

Vaccine preventable GI diseases

Answer 13

Typhoid, HAV

Question 14

What is responsible for most traveler’s diarrhea? How does this affect your treatment in a patient?

Answer 14

80% of traveler’s diarrhea is bacterial so you would give them abx before they go. Note that they should not self treat for dysentery, but can self treat with normal watery traveler’s diarrhea.

Question 15

Group preferred for azithromycin when traveling

Answer 15

Pregnant woman and children due to potential for MSK disorders w/fluoroquinolones. SE asia due to campylobacter resistant bacteria.

Question 16

Pre-exposure prophylaxis for traveler’s diarrhea

Answer 16

Rifaximin

Question 17

Most important steps in a foodborne outbreak

Answer 17

Confirm the existence of an outbreak and confirm the diagnosis.

Question 18

Staph incubation

Answer 18

2-6 hours vomiting/diarrhea from food handlers

Question 19

B. cereus incubation

Answer 19

1-15 hours, vomiting/diarrhea w/rice

Question 20

Salmonella incubation

Answer 20

6-48 hours, associated with animal foods

Question 21

Campylobacter incubation

Answer 21

2-5 days, sporadic, milk/poultry

Question 22

Most important prevention for norovirus

Answer 22

Hand washing

Question 23

Highly transmissible in crowded settings via water source. Treating it?

Answer 23

Cholera. Field sanitation and water sanitation

Question 24

Person-to-person dysentery

Answer 24

Shigella

Question 25

Chronic diarrhea w/cramping after camping trip w/insidious onset. Treatment?

Answer 25

Giardia. Treated w/metronidazole.

Question 26

Methods for water treatment?

Answer 26

Heat, halogenation, coagulation/flocculant (clumps particles), filtration (viruses can still get through)

Question 27

Deployed environment workhorse for water

Answer 27

Reverse osmosis water

Question 28

What does chlorinated water not kill?

Answer 28

Cryptosporidium or cyclospora